Combination of Increased Flip Angle, Radial k-Space Trajectory, and Free Breathing Acquisition for Improved Detection of a Biliary Variant at Living Donor Liver Transplant Evaluation Using Gadoxetic Acid–Enhanced MRCP

Rosenkrantz, Andrew B.; Block, Tobias; Hindman, Nicole; Vega, Emilio; Chandarana, Hersh

doi:10.1097/rct.0000000000000071

Cited by 8 publications

(3 citation statements)

References 23 publications

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“…Insu cient enhancement during the HBP can cause poor contrast differences between background liver parenchyma and a focal hepatic lesion without uptake of Gd-EOB-DTPA 7,28 . If insu cient enhancement during the HBP can be predicted in advance, image quality can be improved by a delay of the time to obtain the HBP or modi cation of several sequence parameters such as ip angle and K-space 29,30 . Therefore, it is clinically important to predict insu cient enhancement of liver parenchyma before performing Gd-EOB-DTPA-enhanced MRI.…”

Section: Discussionmentioning

confidence: 99%

Machine learning approach for prediction of hepatic enhancement during the hepatobiliary phase of Gd-EOB DTPA-enhanced MRI.

Byun

Park

et al. 2021

Preprint

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We retrospectively assessed 214 patients with chronic liver disease or liver cirrhosis who underwent magnetic resonance imaging (MRI) enhanced with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) from August 2016 to May 2020 to evaluate the relationship between biochemical results that reflect liver function and hepatic enhancement. With the information gained we employed a machine learning approach with the K-Nearest Neighbor (KNN) algorithm to develop a predictive model for determining insufficient hepatic enhancement during the hepatobiliary phase (HBP) in Gd-EOB-DTPA-enhanced MRI. Using both quantitative and qualitative assessments, the total bilirubin (TB), albumin (Alb), prothrombin time-international normalized ratio, platelet, Child-Pugh score (CPS), and Model for End-stage Liver Disease Sodium (MELD-Na) score were related to decreased hepatic enhancement. In a multivariate analysis, TB and Alb were associated with insufficient enhancement (p < 0.001). The predictive model showed that a combination of a variety of biochemical parameters had better performance (accuracy = 82.8%, area under the curve (AUC) = 0.861) in predicting insufficient enhancement than either the CPS (accuracy = 79.5%, AUC = 0.845) or the MELD-Na score (accuracy = 80.8%, AUC = 0.821). By using a machine-learning-based predictive model with the KNN algorithm, radiologists can predict insufficient hepatic enhancement during HBP in advance and adjust each patient's individually optimized MRI protocol.

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Section: Discussionmentioning

confidence: 99%

Machine learning approach for prediction of hepatic enhancement during the hepatobiliary phase of Gd-EOB DTPA-enhanced MRI.

Byun

Park

et al. 2021

Preprint

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“…Various measures, such as extending the delay time of HBP, or changing acquisition parameters of the MRI sequence, can be taken to improve liver parenchymal enhancement during HBP if it can be predicted beforehand that the performance of Gd-EOB-DTPAenhanced MRI will be poor (14)(15)(16)(17). Therefore, it is clinically important to be able to predict degree of liver parenchymal enhancement prior to conducting a Gd-EOB-DTPA-enhanced MRI.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a predictor of insufficient enhancement during the hepatobiliary phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging

et al. 2017

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Background Insufficient enhancement of liver parenchyma negatively affects diagnostic accuracy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, there is no reliable method for predicting insufficient enhancement during the hepatobiliary phase (HBP) in Gd-EOB-DTPA-enhanced MRI. Purpose To develop a predictor for insufficient enhancement of liver parenchyma during HBP in Gd-EOB-DTPA-enhanced MRI. Material and Methods In order to formulate a HBP enhancement test (HBP-ET), clinical factors associated with relative enhancement ratio (RER) of liver parenchyma were retrospectively determined from the datasets of 156 patients (Development group) who underwent Gd-EOB-DTPA-enhanced MRI between November 2012 and May 2015. The independent clinical factors were identified by Pearson's correlation and multiple stepwise regression analysis; the performance of HBP-ET was compared to Child-Pugh score (CPS), Model for End-stage Liver Disease score (MELD), and total bilirubin (TBIL) using receiver operating characteristic (ROC) curve analysis. The datasets of 52 patients (Validation group), which were examined between June 2015 and Oct 2015, were applied to validate the HBP-ET. Results Six biochemical parameters independently influenced RER and were used to develop HBP-ET. The mean HBP-ET score of patients with insufficient enhancement was significantly higher than that of patients with sufficient enhancement ( P < 0.001) in both the Development and Validation groups. HBP-ET (area under the curve [AUC] = 0.895) had better performance in predicting insufficient enhancement than CPS (AUC = 0.707), MELD (AUC = 0.798), and TBIL (AUC = 0.729). Conclusion The HBP-ET is more accurate than routine indicators in predicting insufficient enhancement during HBP, which is valuable to aid clinical decisions.

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“…Various sequence modifications can optimize results. In particular, an increased flip angle can improve contrast between the biliary tree, radial k-space sampling can minimize motion artifacts, and free-breathing acquisition can improve signal-to-noise ratio (31). In addition, intravenous low-dose morphine has been shown to distend and improve bile duct visualization in gadoxetate disodium enhanced MRCP (32).…”

Section: Biliary Imagingmentioning

confidence: 99%

Adult living donor liver imaging

Cai

Yeh²,

Westphalen³

et al. 2016

Diagn Interv Radiol

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L iver transplantation is the treatment of choice for end-stage liver disease (ESLD), such as that from alcoholic cirrhosis or viral hepatitis. The demand for donor livers is increasing, outstripping the available supply and creating a long waiting list of patients with ESLD, many of whom die while on the waiting list. Increasingly, living donor liver transplantation (LDLT) is seen as a viable alternative to deceased donor liver transplantation to increase the supply of available donor livers. Studies of LDLT have shown acceptable results in terms of short-term survival and graft outcomes compared with deceased donor liver transplantation with full size organ (1) and long-term donor quality of life (2). In the nine-center adult-to-adult living donor liver transplantation cohort study (A2ALL), one-year graft survival was 81% (3) and most living donors maintained an above average health-related quality of life at 11 years postoperatively (4). In addition, recent advancements in surgical techniques and presurgical evaluation and preparation have continued to improve outcomes (5).LDLT is a major surgical undertaking. The healthy donor is subjected to a hemihepatectomy, a surgical procedure with significant risks, without apparent medical benefits to the donor. Studies have shown that living liver donors in the United States have a perioperative risk of mortality of 1.7 per 1000 donors (6), from causes including sepsis and acute liver failure. In addition, numerous other complications can occur after donation, including biliary leaks or stricture, and vascular thrombosis. Thus, careful evaluation and selection of the donors is mandatory to minimize the risks to the donors, as well as to maximize the benefits to the recipients. Preoperative imaging (computed tomography, CT; magnetic resonance imaging, MRI) plays a key role in the evaluation of donors by depicting biliary and hepatic vascular anatomy, liver volumetrics, and parenchymal disease, information that is key to safe LDLT. This review provides an overview of key surgical considerations in LDLT that the radiologists must be aware of, and imaging findings on CT and MRI that the radiologists must convey to the surgeons when evaluating potential donors for LDLT. Types of LDLT and surgical considerationsThe three most commonly harvested grafts for LDLT are left lateral segment, left lobe, and right lobe grafts. The left lateral segment graft, which includes the Couinaud's segments II and III, is usually used for pediatric recipients or small size recipients. (LDLT) is increasingly used for the treatment of end-stage liver disease. The three most commonly harvested grafts for LDLT are left lateral segment, left lobe, and right lobe grafts. The left lateral segment graft, which includes Couinaud's segments II and III, is usually used for pediatric recipients or small size recipients. Most of the adult recipients need either a left or a right lobe graft. Whether a left or right lobe graft should be harvested from the donors depends on estimated graft and donor remnan...

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Combination of Increased Flip Angle, Radial k-Space Trajectory, and Free Breathing Acquisition for Improved Detection of a Biliary Variant at Living Donor Liver Transplant Evaluation Using Gadoxetic Acid–Enhanced MRCP

Cited by 8 publications

References 23 publications

Machine learning approach for prediction of hepatic enhancement during the hepatobiliary phase of Gd-EOB DTPA-enhanced MRI.

Machine learning approach for prediction of hepatic enhancement during the hepatobiliary phase of Gd-EOB DTPA-enhanced MRI.

Development and validation of a predictor of insufficient enhancement during the hepatobiliary phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging

Adult living donor liver imaging

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